Provider Demographics
NPI:1851727903
Name:TULLO, SARAH (APRN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TULLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2747
Mailing Address - Country:US
Mailing Address - Phone:877-925-3637
Mailing Address - Fax:203-785-6798
Practice Address - Street 1:800 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2747
Practice Address - Country:US
Practice Address - Phone:877-925-3637
Practice Address - Fax:203-785-6798
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005513363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT005513OtherLICENSE
CT004234788Medicaid